I’ve had hip pain for about a year…I just had MRIs done and found out I have “multiple subchondral cysts noted along the lateral margin of the right femoral head with an aggregate diameter of 1cm” and this may represent femoroacetabular impingement syndrome
My doctor gave me the number of a guy who does hip arthroscopy but says it’s not usually the case for hip impingement.
Any advice???
Call that guy.
Could be the source of all them lower leg problems you been having?
call…that guy…
Okay I just had my appointment with him…he took more X-rays and confirmed that there is indeed an impingement. He wants me to get a more specific MRI done with injections to see how my cartilage and labrum looks, but he seemed pretty convinced that hip scope is the way to go. I asked him if i would be able to set new running records after surgery and he wasn’t too optimistic about that…ughhh…but i cant live with this pain either!! And what if all my other injuries are due to my faulty hip joint?? I think I really have no choice at this point.
Opinions?
Thats what i think
That would be a good thing as far as treatment goes I guess…but I don’t know how well that adds up. Why would my hip only start hurting within the last year then…
i have a lot of clients who have “out” hips yet there is no Dirrect pain caused at the hip. Mostly its (the pain) is directed elsewhere,
knees
ankles
back
shoulders
The above site does a pretty good job of explaining what you’re up against.
I hope your Dr. got more details out of the imaging than simply saying you have impingement.
Hey Matt, I guess my hips aren’t feeling so better now huh =P
Anyways, he moved my hips around in a few motions…basically testing internal vs. external rotation. He also took x-rays of my hips and showed me exactly where the impingement was. I was clearly able to see the abnormal bone growth on the x-ray of my right hip.
He wants me to have an MRI done with injected dye and localized pain killer, which I suppose is to see firstly if I truly have hip impingement, and secondly if I have cartilage/labrum damage.
Sounds like you found a good Dr. in regards to your problem. Many are completely in the dark when it comes to FAI type degenerative patterns.
I really recommend reading the site I listed as it will help you understand what you have and what you’re in for.
In regards to your MRI with dye and anesthetic here’s what it’s for…
“An MRI should be ordered as a left or right hip study with intraarticular gadolinium (contrast dye in the joint) and a pain test. The pain test typically involves placing a local anesthetic inside the hip joint with the contrast dye. Using the pain test helps assess whether the pain is coming from inside the hip joint.”
If you can stomach reading reasearch on different procedures and outcomes for FAI, I have a few PDFs. Just let me know.
Yes please send me the PDFs! I’ve looked at quite a few sites already. Most of them are very optimistic about the surgery…
By the way I read that link, and it basically says in order to treat FAI without surgery I would need to become less active(“permanently” is how I interpreted it). It also says those that have symptoms that last longer than 6 months should consider surgery…
FAI is a structural issue that the only way to possibly change is surgical intervention. You can modify training to enhance function of gluteal/hip stabilizers, and avoid offending means (deep flexion patterns, Internal rotation, large extension values), which for most would mean curtailing what they need to do. It can be “managed” but you won’t suddenly be able to do those activities. If you can’t manage to train around it now it won’t suddenly be manageable. Additionally, continued wear on your hip increases probability of problems down the line.
Here’s the seminal review of the surgery for athletes (also have reviews for active adolescents, revisted hip arthroscopy’s, etc…). Dr. Philippon (senior author) is the pioneer in the surgery intervention for FAI and has more big leauge experience with it than anyone else.
Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression
Marc Philippon,corresponding author Mara Schenker, Karen Briggs, and David Kuppersmith
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1950586&blobtype=pdf
Overall this is still a very new frontier as far as techniques and long term outcomes. Here’s an article discussing potential degeneration between two different types of labral intervention (repair vs debribement) in FAI surgeries.
Differences seen between repair vs. labral debridement for hip impingement at 1 year
Researchers saw a significant increase in radiographic degenerative changes in the debridement group.
By Gina Brockenbrough
1st on the web (October 13, 2008)
October 2008
WASHINGTON — Research indicates that although there is no significant difference in the early clinical outcomes between arthroscopic labral debridement and labral repair for the treatment of femoroacetabular impingement, significant changes were seen between two treatment groups at 1-year-plus follow-up.
In a consecutive series of patients who underwent arthroscopic management for femoroacetabular impingement (FAI), Christopher M. Larson, MD, and colleagues compared the results of those who underwent labral refixation to those who underwent a labral debridement prior to performing any repairs.
The investigators discovered no significant differences between the groups regarding Harris Hip Scores, Visual Analog Scale (VAS) scores for pain, SF-12 scores and alpha angles on both anterior-posterior and lateral views with a minimum follow-up of 1 year. The analysis also revealed no significant differences in these outcomes among patients who had debridement, excisions with rim trimming or repair at that time.
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Delphi Healthcare Partners, Inc.
Degenerative changes
However, “With further follow-up at 1 year and [beyond], there is a statistically significant increase in radiographic degenerative changes in the debridement group and statistically improved Harris Hip scoring in the labral group,” Larson recently told Orthopedics Today.
However, he noted that 5- to 10-year follow-up is needed to fully compare the outcomes and said that follow-up radiographs may detect changes earlier than clinical scores.
“It is a consecutive series, and management with this technique is evolving,” Larson said. “And if a difference does show up with time, the question will remain whether this relates to labral preservation or improved technique in managing impingement.”
Larson presented the study during the 27th Annual Meeting of the Arthroscopy Association of North America.
The investigators studied 80 hips; the labral debridement group included 37 consecutive hips that the researchers studied before performing repairs.
“All of these cases were reviewed and were felt to be repairable by current techniques,” Larson said. Patients in this group had a mean age of 31 years and a mean follow-up of 14 months.
The labral refixation group had a mean age of 27 years and a mean follow-up of 8 months. In both groups, most patients had minimal or no degenerative changes.
Procedures
Patients with pincer impingement underwent a labral debridement, rim trimming and labral refixation with two to six suture anchors. Those with cam impingement had a capsulotomy and a proximal femoral osteochondroplasty.
Surgeons performed 29 femoral osteochondroplasties in the debridement group. Eighteen patients in the group underwent labral debridement without rim trimming and 19 had rim trimming with labral excision. In the refixation group, 36 patients also had a femoral osteochondroplasty and 40 patients underwent rim trimming.
Larson noted that the groups showed good and excellent results postoperatively and that the study investigated labral tears without significant degenerative changes.
“There are finite element models that have suggested that the labrum has a ceiling function,” he said. “In the absence of this sealing, strains within the cartilage matrix increase, which may increase those degenerative changes over time.”
For more information:
* Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; e-mail: [email]Christopher_larson@med.unc.edu[/email]. He receives research or institutional support from Biomet, Omeros Corp., Arthrex Inc. and Zimmer and miscellaneous funding from Smith & Nephew.
Reference:
* Larson CM, Giveans M. Arthroscopic treatment of femoroacetabular impingement: Early outcomes evaluation of labral refixation/repair vs. debridement. Paper #SS-04. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.pm me your email and I’ll send you a few more that you can’t access online.
Well I got the results of the MRI back…
my labrum has some tears, and there is definitely a hip impingement. his own words were “your labrum is pretty beat up…” and he said it’s damaged beyond repair pretty much…he would just trim it down and make it nice and clean…
The signs for hip impingement are:
I have all of those signs…
…so I scheduled my surgery for the beginning of January…it’s either live with impingement and the torn labrum, or have surgery and hopefully slow down the arthritic process…
I wasn’t happy at all hearing that I actually have pretty bad labral tears. I don’t get how bad they could be if I’m still capable of sprinting?
okay nevermind, the tears are worse than I thought. I can’t even jog. you know what im wondering…if its even possible that all of my pain has been a result of a torn labrum and the hip impingement actually didnt cause the tear.
sigh…whatever the labrum is beyond repair…he’s just gonna shave it down. has any pro-athlete achieved good results from a surgery involving labral tears?
surgery is in 3 days…
Good luck man. Hope all goes well.